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02.07 Sterile Field

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Overview

  1. What is a sterile field?
    1. Environment in surgery
      1. Supports aseptic practice/principles
        1. Only sterile items used in a sterile field
          1. Check package
            1. Package will say if sterile
            2. No holes or tears
            3. Expiration
        2. If doubtful sterility
          1. Assume unsterile
          2. “When in doubt, throw it out”
        3. Sterile item is contaminated if
          1. Moisture permeates through
            1. “Strikethrough”
              1. Gown
              2. Sterile supplies
              3. Draping
          2. Touched by unsterile item
    2. Created by sterile drapes
      1. Patient is center of sterile field
  2. Importance
    1. Minimizes exposure to microbials
      1. Avoid surgical site infections (SSI)

Nursing Points

General

  1. Sterile team members
    1. Only touch sterile items/areas
    2. Protect sterile field
  2. Unsterile team members
    1. Must not
      1. Reach over sterile field
      2. Walk in between sterile areas
    2. Must
      1. Approach sterile field
        1. Directly facing

Assessment

  1. Sterile gowns
    1. Sterile from chest to level of sterile field
      1. Sleeves from 2 inches above elbow to cuff
        1. Cuff is not sterile
          1. Covered by sterile gloves
    2. Unsterile areas of gown
      1. Axillary
      2. Shoulder
      3. Back
      4. Neckline
  2. Sterile drapes
    1. Creates sterile field
      1. Over patient
        1. Operative area only in view
      2. Over table for instruments and supplies
    2. Placed by gowned sterile team member
    3. Should not be moved once placed
      1. Placed immediately prior to surgery

Therapeutic Management

  1. Contamination at the sterile field
    1. Removed immediately
    2. Lifted without touching sterile surface
    3. Dropped to
      1. Unsterile team member
      2. Garbage
      3. Unsterile area

Nursing Concepts

  1. Safety
  2. Patient-centered care
  3. Health promotion

Patient Education

  1. Teach patient
    1. What to expect when entering OR
      1. Team members appearance
        1. Gowned
        2. Gloved
        3. Masked
    2. Do not touch anything

Reference Links

Study Tools

Video Transcript

Hey guys I’m super excited to talk to you today about the sterile field that is so important to the surgical patient!

So what is a sterile field?  Basically guys the sterile field is an environment that the surgical team creates in the operating room to minimize exposure of microbials to the patient.  Aseptic principles are the used as the foundation of creating the sterile field. This is super important because it decreases the risk of a surgical site infection or SSI.  The sterile field is created with the use of sterile drapes with the patient being the center of the field. It’s important to know that certain team members are also included within the sterile field when they are wearing a sterile gown.  Guys check out the lesson we have specifically on perioperative team members.

Ok so let’s take a quick look at what some of those aseptic principles are that I just mentioned.  Ok so, only sterile items are used in a sterile field. You might be thinking how do I know if something is sterile? Well if it’s a prepackaged supply it will say “sterile” right on the package. If the item in question is an instrument or something processed by your organizations sterile processing department there will be an indicator on the outside of the package.  Check with your sterile processing department with the specific type of indicators they use. Also guys sterile items absolutely cannot have holes or tears and the expiration date must be within range or it can’t be used on a sterile field. If there is any doubt at all if something is sterile, we as perioperative nurses use this saying “when in doubt, throw it out!”

So continuing on with aseptic principles, when is an item considered contaminated?  So if moisture goes through a gown or drape or even supply this is called “strikethrough” and the item is now considered contaminated and unsterile.  Also, if a sterile item is touched by an unsterile person or thing it is now contaminated.

So we talked about when an item is considered contaminated but what do we do if it occurs?  So guys even those of us who have worked in the surgical environment for tons of years will still occasionally contaminate something…and this includes surgeons.  The important issue is not necessarily the contamination but recognizing that it occurred and doing something about it. So contaminated items should be removed from the sterile field immediately by lifting it without touching the sterile surface. The item should be dropped to an unsterile team member or placed in an unsterile area.

So specifically what can the sterile team members do?  Sterile stays sterile. So basically sterile team members can only touch other sterile items and areas.  Team members that are frequently sterile during surgery are the scrub nurse or tech, assistant, and surgeon.

So what about the unsterile team members?  These team members must always remember that they should never reach over a sterile field or even walk between sterile areas, like between the OR bed where the patient is and the OR table, where the scrub RN or tech is working from.  The unsterile team member should always approach the sterile field facing forward to always be aware of the sterile field. Team members that are often unsterile are the circulating RN and the anesthesia team.

Ok so some specifics of the sterile gown.  When wearing the sterile gown the team member is sterile from the chest to the surgical level.  The sleeves are only sterile up to 2 inches above the elbow. The cuff of the sleeve is not sterile because it often collects moisture but it is covered by sterile gloves.  Also guys even though the entire gown is sterile when it comes out of the packaging and applied using sterile technique the axilla, back, neckline, and shoulders are never, ever considered sterile.  So it definitely can be weird especially for people who are new to the OR. Guys I always make sure to pay special attention to newcomers to the OR to make sure they are not touching anything that they assume might be sterile.

Ok so what about the sterile drapes?  Remember the drapes are used to create the sterile field, over the patient and OR table where the instruments and supplies are.  The only area on the patient that should be viewed is the operative area. The sterile drapes are placed by a sterile team member, the person wearing the sterile gown and they are not moved once they are placed until the end of the procedure.

So guys teach your patients what to expect when entering the operating room.  Where I work the patients are wide awake when they are rolled into the OR so they are able to see everything.  Sometimes it’s shocking, especially for kids to see people completely covered with gowns, masks, and gloves…so prepare them for these sterile people.  Also guys make sure your patient knows not to touch anything when they enter the operating room because it might be sterile. And as always ask questions!

Ok so a few nursing concepts we can apply here.  Of course safety and health promotion are obvious because creating a sterile field is a patient-centered process used to prevent infection in the surgical patient.

Ok guys let’s review a few key points!  The sterile field is an environment created in surgery with drapes which decreases the risk of surgical site infections, and remember the sterile team member is part of the sterile field.  The sterile field follows aseptic principles like only sterile items are used on the sterile field, contamination occurs with strikethrough and contact with unsterile items, and remember guys “when in doubt, throw it out!”  The sterile gown is sterile from the chest to the surgical level and to 2 inches above the elbow. The back, neckline, shoulders, and axilla are not sterile. Sterile drapes create the sterile field over the patient and the OR table placed by the sterile team member.  And finally teach the patient what they will see when they enter the OR and not to touch anything.

Okay guys I hope you enjoyed this lesson on the sterile field!  Make sure you check out all the resources attached to this lesson, as well as the rest of the lessons in this course including a specific lesson in nursing skills on how to apply sterile gloves! Now, go out and be your best self today. And, as always, happy nursing!

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